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Interventions to improve cardiovascular risk factors in people with serious mental illness

Gierisch, Jennifer M, author
Effective Health Care Program (US), issuing body
United States Agency for Healthcare Research and Quality, issuing body
Duke University Evidence-based Practice Center, issuing body
Interventions to improve cardiovascular risk factors in people with serious mental illnessĀ / prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Duke Evidence-based Practice Center; investigators, Jennifer M. Gierisch [and 10 others].
Comparative effectiveness reviews ; number 105
AHRQ publication ; no. 13-EHC063-EF
Country of Publication:
United States
Rockville, MD : Agency for Healthcare Research and Quality, [2013]
1 online resource (1 PDF file (various pagings)) : illustrations
Electronic Links:
OBJECTIVES: Individuals with serious mental illness (SMI) have excess mortality from cardiovascular disease (CVD) and high rates of CVD risk factors such as diabetes, obesity, and hyperlipidemia. We conducted a systematic review to evaluate interventions to improve CVD risk factors in adults with SMI. DATA SOURCES: We searched PubMed(r), Embase(r), PsycINFO(r), and the Cochrane Database of Systematic Reviews for English-language trials published since 1980 that evaluated patient-focused behavioral interventions, peer or family support interventions, pharmacological treatments, and multicondition lifestyle interventions, or their combination, that targeted weight control, glucose levels, lipid levels, or CVD risk profile among adults with SMI at elevated risk of CVD. REVIEW METHODS: Two investigators screened each abstract and full-text article for inclusion, abstracted data, and performed quality ratings, efficacy-effectiveness ratings, and evidence grading. Qualitative and quantitative methods, using random-effects models, were used to summarize results. RESULTS: Of 35 eligible studies, most enrolled patients with schizophrenia who were prescribed antipsychotics. Most studies were designed to control weight (n=28); one study specifically addressed diabetes management, none targeted hyperlipidemia, and three were multicondition interventions. Most studies were efficacy trials comparing behavioral interventions with control; none evaluated peer and family support. There were few direct comparisons of active interventions; effects on overall CVD risk, physical functioning, or cardiovascular events were reported rarely. Compared with controls, behavioral interventions (mean difference [MD] 3.13 kg; 95% CI, 4.21 to 2.05), metformin (MD 4.13 kg; CI, 6.58 to 1.68), the anticonvulsive medications topiramate and zonisamide (MD 5.11kg; CI, 9.48 to 0.74), and adjunctive or antipsychotic switching to aripiprazole improved weight control. However, aripiprazole switching may be associated with higher rates of treatment failure. Nizatidine did not improve any outcome. The evidence was insufficient for all other interventions and effects on glucose and lipid control. CONCLUSIONS: Few studies have evaluated interventions to address one or more CVD risk factors in patients with SMI. Comparative effectiveness studies are needed to test multimodal strategies, agents known to be effective in non-SMI populations, and antipsychotic-management strategies.
Cardiovascular Diseases/prevention & control*
Mentally Ill Persons
Risk Factors
Title from PDF title page.
"April 2013."
Includes bibliographical references.
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 540 Gaither Road, Rockville, MD 20850; Contract No. 290-2007-10066-I, Prepared by: Duke Evidence-based Practice Center, Durham, NC.
Description based on version viewed: June 26, 2013.
101609827 [Electronic Resource]

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